Healthcare Provider Details

I. General information

NPI: 1770322323
Provider Name (Legal Business Name): TAYANA FERNANDEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N GRAND AVE STE B
GAINESVILLE TX
76240-2833
US

IV. Provider business mailing address

5800 N INTERSTATE 35 STE 205
DENTON TX
76207-1438
US

V. Phone/Fax

Practice location:
  • Phone: 940-580-3389
  • Fax:
Mailing address:
  • Phone: 940-220-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: